背景:术后粘连的发生率与重复肝切除术的难度直接相关。然而,发病率,location,与肝切除术相关的手术程序相关的术后粘连的严重程度尚不清楚。
方法:从168例接受第二次肝切除术的患者的手术记录和/或录像中评估第一次肝切除术引起的硬致密粘连。
结果:术后肝脏周围硬致密粘连的发生率与部位显著相关,比如肝切面,肝脏周围的解剖区域,和腹膜周围切口,和肝切除术相关的手术程序,如Pringle动作和胆囊切除术。解剖后,右肝周围坚硬致密粘连的发生率高于左内肾下间隙。Further,即使在没有进行Pringle手术的患者中,肝十二指肠韧带或Morison袋周围坚硬致密粘连的发生率也大于30%,胆囊切除术,或肝肾韧带解剖.尽管开腹肝切除术后切口周围腹膜硬致密粘连的发生率高于腹腔镜肝切除术后,使用粘连屏障可降低开放式肝切除术后患者发生此类粘连的发生率。
结论:与肝切除术相关的手术程序,如肝周解剖,Pringle动作和胆囊切除术与术后硬致密粘连直接相关。然而,即使不进行上述手术,术后肝十二指肠韧带和Morison袋周围硬致密粘连的发生率也很高.这些发现可能有助于告知关于在肝切除术期间使用粘连屏障的适应症和部位的临床决定。
BACKGROUND: The incidence of postoperative adhesions is directly correlated with the difficulty level of repeat hepatectomies. However, the incidence, location, and severity of postoperative adhesions in relation to hepatectomy-related operative procedures are yet unclear.
METHODS: First hepatectomy-induced hard dense adhesions were evaluated from the surgical records and/or videos of 168 patients who underwent second hepatectomies.
RESULTS: The incidence of postoperative hard dense adhesions around the liver was significantly associated with locations, such as the hepatic cut surface, dissected areas around the liver, and peri-incision peritoneum, and hepatectomy-related operative procedures, such as Pringle maneuver and cholecystectomy. The incidence of hard dense adhesions after dissection was higher around the right liver than in the left infraphrenic space. Further, the incidence of hard dense adhesions around the hepatoduodenal ligament or Morison pouch was greater than 30% even in patients who did not undergo Pringle maneuver, cholecystectomy, or hepatorenal ligament dissection. Although the incidence of hard dense adhesions of the peritoneum around the incision was higher after open hepatectomy than after laparoscopic hepatectomy, adhesion barrier use reduced the incidence of such adhesions in patients after open hepatectomy.
CONCLUSIONS: Hepatectomy-related operative procedures such as peri-hepatic dissection, Pringle maneuver and cholecystectomy are directly associated with postoperative hard dense adhesions. However, the incidence of postoperative hard dense adhesions around the hepatoduodenal ligament and Morison pouch was high even when the above-mentioned operative procedures were not performed. These findings may help inform clinical decisions regarding the indications and sites for adhesion barrier use during hepatectomies.